Patient-reported symptom-mapping in carpal tunnel syndrome.

INTRODUCTION: To date, no method has been described or utilized to study the distribution of symptoms in carpal tunnel syndrome. We describe a technique of symptom-mapping that yields a population-based "anatomic profile" of carpal tunnel syndrome. METHODS: Symptoms were mapped on visual questionnaires depicting the volar hand, wrist, and forearm. Thirty-four hands in 26 patients with isolated carpal tunnel syndrome were included in the study. RESULTS: Painful symptoms were clearly centered over the carpal tunnel and were reported much less frequently in the digits. Nonpainful sensory disturbances (e.g., numbness, paresthesias) were found to have a much more peripheral and lateral distribution. DISCUSSION: Our technique serves to establish a population-based "anatomic profile" of carpal tunnel syndrome, assisting with clinical diagnosis and serving as a reference point for the comparison of pretreatment and posttreatment clinical data. Muscle Nerve 59:321-325, 2019.

Epidemiologic dynamics contributing to pediatric wrist fractures in the United States.

BACKGROUND: The purpose of this study was to explore and evaluate national trends and factors contributing to pediatric wrist fractures. METHODS: Over a 16-year period from January 1998 to December 2013, we identified and reviewed patients aged 0-17 years old with the primary diagnosis of wrist fracture, as evaluated in US EDs and chronicled by the National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission. We conducted descriptive epidemiologic, bivariate, and chi-square analyses. Patients were categorized into age-defined subgroups and further stratified by sex, race, location, and consumer product/activity associated with injury. RESULTS: There were 53,265 children evaluated in NEISS EDs (national estimate, 1,908,904) with wrist fractures from 1998 to 2013. Mean age was 10.9 years, with 64 % males and 36 % females. The most common locations of injury were place of recreation/sports, home, and school. The top five consumer-product-related injuries were associated with bicycles, football, playground activities, basketball, and soccer. The highest subgroup associations were with beds (0-12 months), stairs (13-36 months), playgrounds (3-5 and 6-10 years), and football (11-17 years). The greatest increase in fractures occurred between ages 0-12 and 13-36 months, with the second-largest increase between ages 3-5 and 6-10. CONCLUSIONS: It is essential to develop injury prevention and safety strategies as well as identify individual risk factors for fracture, including activity, sex, and key age transitions. Surveillance is imperative to advance our understanding of these fractures, and in the future may facilitate development of research prediction tools to anticipate or prevent injury.

Proximal row carpectomy versus scaphoid excision and intercarpal arthrodesis: intraoperative assessment and procedure selection.

PURPOSE: To demonstrate the relative frequency of degenerative changes of the radiolunate and capitolunate joints in osteoarthritis of the wrist as seen by direct visualization, and to demonstrate the disparity between findings on preoperative radiographs and direct visualization. METHODS: We reviewed 18 consecutive patients who underwent either a proximal row carpectomy (PRC) or a scaphoid excision and 4-corner arthrodesis (SEFCA) for symptomatic degenerative arthritis of the wrist. In each case, the articular surfaces of the radiolunate and capitolunate joints were inspected intraoperatively; based on the relative degree of degenerative changes, either a PRC or an SEFCA was performed. We compared preoperative radiographs and the predicted procedure based on them with intraoperative findings and the procedure actually performed. RESULTS: Of 18 wrists, 15 had more severe degenerative changes on the proximal articular surface of the lunate than on the capitate head and underwent a PRC; the remaining 3 had more severe changes on the capitate head than on the proximal surface of the lunate and underwent an SEFCA. In contrast, preoperative radiographs in 13 of the 18 cases revealed degenerative changes at the capitolunate joint and minimal or no changes at the radiolunate joint. An SEFCA was the predicted procedure in all 13, but was performed in 3. The remaining 10 underwent a PRC. CONCLUSIONS: Preoperative radiographs did not correlate well with intraoperative findings in the assessment of degenerative changes at the radiolunate and capitolunate joints, with changes at the radiolunate joint often underestimated. Our findings contradict the widely held contention that the radiolunate joint is consistently spared in osteoarthritis. The lunate fossa of the radius appears to be consistently spared, but not the proximal surface of the lunate. We recommend intraoperative assessment of the articular surfaces, rather than preoperative radiographs, for selection of the surgical procedure. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.